Genetic Insights into the Risk of Repeated Falls
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Genetic Insights into the Risk of Repeated Falls
Date of Content: May 9, 2024
Written by: Harvey Talento
Reviewed by: Maarit Tiirikainen, PhD
Overview
Repeated falls in older adults pose significant risks, impacting their quality of life and healthcare costs. Factors such as reduced muscle mass, muscle strength, and environmental hazards contribute to the vulnerability of older adults to falls. Studies indicate that a considerable percentage of older adults experience repeated falls, with risk factors including the use of antidepressants, depression, and limited physical activity. Falls in older adults are a leading cause of injury-related deaths, with about 36 million falls reported annually in the United States alone, leading to injuries that require medical treatment and restrict daily activities. Recurrent falls can result in functional decline, mortality, and a cascade of individual and socioeconomic problems, emphasizing the importance of preventive measures and comprehensive assessments to identify and address the risk factors associated with falls in older adults.
Increased Vulnerability with Repeated Falls
Research suggests that a single fall significantly increases the likelihood of experiencing another one. This escalating risk stems from several factors. First, a fall can lead to physical injuries like fractures, which can impair mobility and balance, making future falls more likely. Second, the psychological impact of a fall can be substantial, with older adults developing a fear of falling that can lead to social isolation and decreased physical activity, which further increases fall risk. Finally, recurrent falls are often a marker of underlying health conditions that contribute to falls, such as balance problems, muscle weakness, or cognitive decline.
Consequences of Repeated Falls
Repeated falls in older adults can have a cascading effect on their physical and mental well-being. Here’s a breakdown of the potential consequences:
Physical Consequences
- Injuries: Falls can cause a range of injuries, from minor scrapes and bruises to serious fractures like hip fractures. Hip fractures can be particularly debilitating, often requiring surgery and extensive rehabilitation. In some cases, they can lead to a loss of independence and even increased mortality risk.
- Pain: Both acute pain from injuries and chronic pain from conditions like arthritis can be exacerbated by falls, making it more difficult for older adults to stay active and mobile.
- Reduced mobility: The fear of falling or physical limitations caused by injuries can lead to a decline in mobility. Older adults may become less likely to leave their homes or participate in activities they previously enjoyed, leading to a decrease in overall fitness and function.
- Hospitalization: Serious injuries from falls often require hospitalization, which can be disruptive and stressful for older adults. It can also lead to a decline in functional abilities and an increased risk of institutionalization.
Mental and Emotional Consequences
- Fear of falling: Fear of falling is a common consequence of a previous fall. This fear can significantly impact the quality of life, leading older adults to avoid activities they perceive as risky and restrict their social interactions.
- Loss of confidence: Repeated falls can erode self-confidence and make older adults feel less independent. This can lead to feelings of helplessness and depression.
Social isolation: The fear of falling or physical limitations can lead to social isolation, as older adults may withdraw from activities or social gatherings for fear of falling again.
Overall Impact
The cumulative effect of these physical and mental consequences can be a significant decline in an older adult’s overall health and well-being. Repeated falls can lead to a loss of independence, decreased quality of life, and even an increased risk of mortality.
How Genetics May Influence The Risk of Repeated Falls
Genetics can play a role in influencing the risk of repeated falls in older individuals. A large GWAS study conducted on the UK Biobank population revealed that falls have a genetic component, with about 35% of the variability in the likelihood of experiencing at least one incident fall and 45% of the variability in the risk for recurrent falls being attributed to genetic factors.
The study was conducted among over 89,000 cases and 362,000 controls. Despite the complex genetic architecture of fall risk, the study identified several previously indicated, and three novel fall-associated loci, and found a small but significant SNP-based heritability of 2.7% with these novel loci alone.
The three novel fall-associated loci were located at 7p21.3 (rs2709062), 19q12 (rs2111530), and 5q21.3 (rs243110).Â
To highlight one of the new genetic loci; the variant rs2111530 maps close to the gene TSHZ3 and its antisense. TSHZ3 is a gene encoding a zinc-finger transcription factor that is suggested to have a role in cortical development and in the pathogenesis of neurodevelopmental disorders.
In addition, the studies on cerebellum tissue showed the highest gene expression enrichment for the 3 fall-associated variants, suggesting that biological processes related to movement control, locomotion, adaptation of posture, and dynamic regulation of balance may play a role in shaping the complex mechanisms underlying fall risk.
Additionally, the study found that the risk of falling also had positive genetic correlations with fractures, insomnia, neuroticism, depressive symptoms, and different medications, and negative genetic correlations with muscle strength, intelligence, and subjective well-being.
Non-Genetic Factors Influencing The Risk of Repeated Falls
Several factors contribute to the risk of repeated falls in older adults. These can be broadly categorized into intrinsic and extrinsic factors.
Intrinsic Factors (Relating to the Individual)
- Musculoskeletal issues: Age-related decline in muscle strength, balance, and flexibility makes falls more likely. Conditions like arthritis can further limit mobility and coordination.
- Vision problems: Poor vision can impair depth perception and make it difficult to navigate uneven surfaces or obstacles, increasing fall risk.
- Medical conditions: Certain medical conditions like Parkinson’s disease, dementia, or chronic pain can affect balance, gait, and cognitive function, all contributing to falls.
- Medications: Some medications, particularly those affecting blood pressure or the nervous system, can cause dizziness or drowsiness, increasing fall risk. A medication review can help identify if adjustments are needed.
Foot problems: Foot pain, ill-fitting footwear, or poo
Extrinsic Factors (Environmental Hazards)
- Home safety hazards: Poor lighting in hallways or bathrooms, loose rugs, uneven surfaces, clutter, or lack of grab bars in showers and bathrooms significantly increase the risk of falls.
- Footwear: Wearing shoes with poor traction or improper support can contribute to slips and falls.
Additional Considerations
- Fear of falling: A psychological consequence of a previous fall, the fear of falling can lead to social isolation and decreased physical activity, both of which further increase fall risk.
- Nutritional deficiencies: Vitamin D deficiency, for example, can contribute to muscle weakness and bone health problems, both of which increase fall risk.
The Importance of Prevention
Given the significant risks associated with recurrent falls, prevention becomes paramount. A multi-pronged approach that addresses both intrinsic and extrinsic factors is most effective.
Addressing intrinsic factors may involve:
- Exercise programs to improve strength, balance, and flexibility
- Vision assessments and correction of any impairments
- Medication review to identify and potentially adjust medications that may affect balance
- Physical therapy to address gait and balance issues
Modifying extrinsic factors includes:
- Improving home safety by removing clutter, installing grab bars, and ensuring adequate lighting
- Wearing proper footwear with good traction
- Using assistive devices like canes or walkers when needed
About the LifeDNA Aging Report
Understanding your personal risk factors for falls can significantly help in preventing them, especially as you age. The LifeDNA Aging Report offers a comprehensive genetic analysis that provides personalized insights into various aspects of aging, including your risk for repeated falls. This report evaluates your genetic predisposition to falls and provides actionable health advice tailored to your unique genetic profile. By knowing your specific risks, you can take proactive measures such as modifying your home environment, adjusting your exercise routine, and consulting with healthcare providers to mitigate these risks effectively.
Empower yourself with knowledge and take control of your wellness journey. The LifeDNA Aging Report is a valuable tool that offers you the information needed to make informed decisions and adopt a proactive approach to aging. Don’t wait for a fall to happen – order your LifeDNA Aging Report today.
Summary
- Repeated falls in older adults greatly affect their quality of life and healthcare costs.
- Approximately 36 million falls are reported annually in the U.S., often leading to serious injuries and restricted daily activities.
- Falls can cause severe injuries like fractures and reduced mobility, often leading to hospitalization.
- Fear of falling and loss of confidence can result in social isolation and depression.
- Genetics account for 35% of the variability in single falls and 45% in recurrent falls.
- Key genetic loci associated with fall risk are SNPs rs2709062, rs2111530 near TSHZ3, and rs243110.Â
- Fall risk is genetically correlated with fractures, insomnia, neuroticism, depressive symptoms, muscle strength, and overall well-being.
- Non-genetic factors of risk of repeated falls include musculoskeletal issues, vision problems, certain medical conditions, medications, and foot problems.
- Home safety hazards and poor footwear significantly increase fall risk.
- A comprehensive approach involving exercise, vision assessments, medication reviews, physical therapy, and home safety improvements is essential to reduce fall risk.
References
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6509467/
- https://www.msdmanuals.com/en-jp/professional/geriatrics/falls-in-older-adults/falls-in-older-adults
- https://www.sciencedirect.com/science/article/abs/pii/S0378512220304242
- https://www.cdc.gov/falls/facts.html
- https://www.ncbi.nlm.nih.gov/books/NBK235613/
- https://www.ncbi.nlm.nih.gov/books/NBK557971/
- https://www.nature.com/articles/s42003-020-01256-x
- https://www.msdmanuals.com/professional/geriatrics/falls-in-older-adults/falls-in-older-adults
- https://www.nia.nih.gov/health/falls-and-falls-prevention/falls-and-fractures-older-adults-causes-and-prevention
- https://www.researchgate.net/publication/11471956_Preventing_falls_in_older_people_Impact_of_an_intervention_to_reduce_environmental_hazards_in_the_home
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